The discs lie between the vertebrae at the front of the spine. The disc has a soft centre (nucleus pulposus) and a tough outer layer (annulus fibrosus). The nerve roots coming out of the spine pass very close to the disc. Sometimes the outer layer of the disc becomes weakened allowing the disc to bulge or for the soft centre to protrude through the disc wall. As a result the nerve can be irritated and becomes painful. Nerve pain is usually felt along the path of the nerve, which varies depending on which nerve root is affected. Nerve pain is often very difficult to control with pain killers.
Sometimes the nerve does not function and weakness and numbness can occur. Rarely bowel and bladder function can be effected. If such neurological symptoms are experienced they should be reported immediately as they may require emergency treatment.
What is Microdiscectomy surgery?
Microdiscectomy is designed to take away the disc which is irritating the nerve resulting in resolution of the leg pain. The procedure is performed using a small incision in the middle of the back. The spine is approached and a small window is made in the spinal canal. The nerves are identified, protected and gently moved to expose the disc.
The disc is removed to decompress the nerve and the canal and disc space is explored to identify any other "loose fragments" which could cause problems later. A microscope is used to improve light and vision enabling a minimal access approach to be used.
When possible an anti adhesion gel is used to coat the nerve root to reduce the risk of tethering due to scar tissue.
The wound is closed with absorbable sutures leaving a short scar with no cross hatching and no need for suture removal. Occasionally the suture ends do require trimming.
Why is it necessary?
It is important to note that not all spinal patients or spinal conditions require surgery. Surgery is usually reserved for significant or excruciating pain, disability, weakness and/or if other conservative measures like physiotherapy and painkillers have not helped in getting rid of the pain. If the surgeon and the patient (after review of the various treatments that the patient has tried), conclude that surgery is the best way forward, then it is up to you to weigh the information given and come to a decision on whether or not you would be willing to proceed with the operation proposed. You should ask questions to clear any doubts in your mind and the information provided here will help to a certain extent.
What are the benefits?
The main aim of this operation is is to help you get relief from your leg pain either partially or totally so that you can then get on with your life. This can be achieved in 4 out of 5 patients with a disc prolapse and who undergo a microdiscectomy. Following a spinal decompression for claudication, most patients can expect about 50% reduction in the claudication leg symptoms.
While the aim of the operation is to hope and expect that you will be pain free, it is important to note that this is not always the case and if we can achieve a significant amount of pain control/reduction so as to get you back to your normal life and work, then surgery could still be considered as significantly beneficial.
Downside and long term effects?
No surgery is without complications. Some complications can be serious and even fatal.
Most patients are pleased with the result of their surgery and do not suffer any adverse outcomes. Occasionally, complications do occur and can require further treatment. Most complications can be treated effectively and problems rectified. In some cases, surgery can be life-changing and can leave patients worse off in the long term.
Nerve damage is rare during surgery. If it occurs it can cause areas of numbness, pins and needles and weakness. Neuralgic pain can also be troublesome.
Cauda equina syndrome is very rare and occurs when the nerves to the bowel, bladder and sexual function are effected. Any numbness around the bottom or problems with passing stool or water should be reported immediately.
Scar tissue can form around the nerve root, tethering the nerve causing ongoing pain. A gel is used whenever possible to reduce the risk of this happening. Occasionally further surgery is required to free up the nerve.
Infections can occur in the wound and rarely deep in the disc. These can be treated with antibiotics but occasionally require surgical cleaning and debridement.
Recurrence can occur as the bone, ligaments and disc heal and may require a further decompression.
Residual material can sometimes be left behind despite careful exploration and further exploration may be required.
Damage to the lining of the nerve root (Dura) can result in a leak of brain fluid connected to the spine (CSF). This is usually noticed and repaired at the time of surgery. A short period of bed rest is advised after the operation. Rarely the leak persists and has to be repaired surgically.
Following surgery, due to the underlying degeneration and/or surgery, the spine may become painful and sometimes unstable. It causes aching in the low back and sometimes further leg symptoms. It is usually treated with pain relief and physiotherapy and some modification of activity. Occasionally further surgery can be helpful.
Bleeding, most commonly from the small veins within the spine can be troublesome and is controlled at the time of surgery. Rarely bleeding continues post operatively and a second procedure is required to control it. If a collection of blood occurs (Seroma), drainage surgically may be required.
Neuralgic pain occasionally persists after surgery despite successful discectomy, and is thought to be due to inflammation, damage and fibrosis inside the nerve itself. This cannot be treated surgically.
Anaesthetic complications will be explained by your anaesthetist.
Please be assured that every effort is made to avoid the complications listed and any others which can rarely occur.
How to prepare for surgery?
Surgery should be considered as a significant event in your lifetime and hence it is important that you prepare for it appropriately. The first step would be to optimise your medical conditions and health. Having a consultation with your GP about this is usually recommended and helpful. Weight loss is desirable and encouraged. It is also advised that you read up about the spinal operation that you have given consent to and clear up any queries prior to the surgery with your spinal surgical team or with your own doctor/GP.
If there is any ongoing treatment (even for an unrelated condition) or if there is any possibility that you are pregnant, it is very important that we are informed.
Also if there is any change to your neurological condition or your pain…… for example, the pain has gone away; you have developed a recent weakness; you have developed numbness in your private parts or in your bottom; if you have developed new bladder or bowel symptoms then it would be appropriate for us to be informed of this. You may need telephonic advice, an urgent evaluation,further scans, urgent/emergency surgery or surgery to be postponed as a result.
You will be given further advice regarding how to prepare for surgery at your pre assessment visit. If you have got any questions, it would be advisable that you ask those at that visit,
How long does it take to recover?
OHGs integrated physio treatment post-op Is administered and delivered through the physionet network. This will be explained to you and organised for you so as to maximise the post-operative recovery.
Our physiotherapy network partners, Physionet+, work closely to support One Health, providing a modern, experienced and seamless physiotherapy service for patients who have undergone surgery. PhysioNet+ provide care across the region, which means One Health patients can receive physiotherapy and rehabilitation locally.
The information below is best viewed as a short and concise advice sheet which can be used for easy reference
You will be given appropriate advice regarding wound care, movement and pain control during your hospital stay and at discharge from the hospital. It is more than likely that you will be also seen and advised by the in-hospital physiotherapist.
Looking after your wound is the same as looking after any other wound in your body. You should try to keep the dressing dry though it can be sponged down if required. Keep the wound clean · always wash your hands before touching the wound. Keep the wound dry with a clean towel - do not soak in a bath. You can wear normal clothes, but be careful not to catch and pull on the stitches or clips. It may be more comfortable, if you avoid direct pressure on the wound for the first few days. Most of wounds heal uneventfully. local pain in the wound is normal al first, but it improves day by day.You will have a wound check after l0-12 days, and the nurse will remove any stitches or clips.
Pain control instructions
Simple painkillers like paracetamol and ibuprofens are usually sufficient to control the post-operative pain. Some patients who have chronic pain will already be on substantially more painkillers and the advice is that they should continue taking it in the immediate post-operative period. Some patients will be prescribed a short course of diazepam for a maximum of 2 weeks in the immediate post-operative period
Advice on movement
Here are some simple tricks you can use to get going:
- To get out of bed, roll on to your side. Swing your legs over the edge of the bed, and at the same time push yourself up sideways into a silting position. Then stand up straight, using both hands to push yourself off the bed - a higher bed will be easier.
- Bend down by bending your knees rather than from your waist for the first few days.
- Try sitting at the washbasin rather than bending over it.
- Use a shower rather than a bath.
- Sit down to put on trousers and socks - it' ll be easier if you avoid tights.
- Use slip on shoes. Or put your foot up on a chair. Use a shoe horn. It's best to avoid long boots.
- Sit on an upright chair with arms. To stand, move to the front of the seat then use your hands to push yourself up.
- Stand and walk about as much as you like.
Try to strike a balance between being as active as you can and not putting too much strain on your back. The basic rules are simple:
- Keep moving - pace your activity.
- Don't stay in one position for too long.
- Move about before you stiffen up.
- Move a little further and faster each day.
- Don't stop doing things - just find an easier way to do them.
Advice on returning back to work
Most people are able to return to work within 2 to 8 weeks - though that varies with the individual, the type of operation and the type of job. Getting back lo heavy work obviously takes longer. Some people with very heavy jobs need to change to lighter work.
Research shows that returning to work sooner rather than later is possible · and it is unlikely lo do any harm. There may be ways to make adjustments to your job that will let you get back earlier
How to receive treatment and who will be my surgeon?
One Health has got a professional and experienced group of spinal consultants supported by an efficient and effective administration and management framework, which will help you get your operation done through our partner hospitals as quickly and effectively as practically possible.
You can either refer yourself directly to the One Health privately (Self-referral to the One Health) by calling 01142505510 or through your GP if you wish to pursue the NHS route of referral.
You can be assured that surgery will be performed by an appropriately qualified spinal consultant. You can choose your consultant by going to our website and identifying which spinal consultant you wish to get referred to in some but not all cases. The patient liaison team (PLT) can guide you through this process if contacted. We try our utmost to make sure that the same spinal consultant follows you throughout your patient pathway and patient experience but this cannot always be guaranteed or possible.